The Massage Message

The word is spreading that massage should be a part of every athletic training room’s offerings. But how do you successfully introduce it to your staff?

By Dr. Debra Brooks

Debra Brooks, PhD, CNMT, LMT, is Chief Executive Officer of the Iowa NeuroMuscular Therapy Center, in Cedar Rapids and Walford, and frequently lectures about sports massage.

Training & Conditioning, 12.7, October 2002, http://www.momentummedia.com/articles/tc/tc1207/massage.htm

Introducing sports massage to a hard-working, time-strapped group of athletic trainers can be a tough sell. If an athletic trainer is going to accept a new technique or modality—and the time required to learn to do it—then you had better prove that it will help the athlete’s performance and health.

This article gives some ideas that I have found to be effective in getting athletic trainers to understand and accept sports massage. The key to this acceptance is to illustrate that sport massage improves the quality of an athlete’s soft tissue, which can deter injury and speed recovery.

First-Hand Learning
The best way to introduce sports massage to your staff athletic trainers is to have them experience it themselves. Experience is a great teacher, especially when the learner actually can feel a difference in his or her body.

Schedule a time slot for a meeting of your entire athletic training staff and have an experienced sports massage therapist—or therapists—give an introduction. Have your invited experts talk about the concepts of sports massage. Have them hand out literature, answer questions, and even show videos.

Then, have the therapists perform pre-event, post-event, or therapeutic massage techniques on the athletic trainers themselves. For the demonstration, the techniques will have to be limited to specific body parts, because a total therapeutic sports massage takes approximately an hour to complete. I have found that this “hands on” approach to the introduction of sports massage is very effective in getting athletic trainers to understand how these techniques work.

(For more information on types of sports massage techniques, see Sidebar, “Techniques” at the end of this article).

As the invited massage therapists perform the massage modalities on your athletic training staff members, discuss how sports massage techniques have specific applications and goals, just as each taping technique has specific applications and goals. The strokes and movements are done for very specific reasons, whether it is to pump up and loosen an athlete for an upcoming event, to sedate tissue and remove metabolic waste after an event, or to provide a regular treatment that keeps the soft tissue in a healthier state. The goal is to help your athletic trainers understand that sports massage is not simply rubbing lotion over a sore spot on the body.

Another step that I take when I introduce sports massage to athletic trainers is to stress that sports massage is a therapeutic activity that comes from a philosophy that views healthcare as a preventive effort. It focuses on treating the athlete before injuries occur in order to maintain good health. Introducing this thought to your staff athletic trainers will help them see that sports massage is in line with their own basic mission, which is to keep the athletes in the best shape for as long as possible.

Once you teach your staff athletic trainers how sports massage can speed recovery and reduce the chances of some injuries, you must then address the issue of time. One very common—and important—question that I hear from athletic trainers: “How do I fit another modality such as therapeutic sports massage into my already busy athletic training schedule? I already feel that I am stretched too thin.”

Answer that important concern by noting that sports massage, when properly implemented, will save time over the long run because athletes whose soft tissue is in top shape tend to recover quicker from injuries. For example, a 1990 study at Cal State Fullerton found that a combination of post-exercise sports massage combined with cool-down exercises significantly reduced blood lactate levels.

Putting massage therapists on sports-medicine staffs has become the rule rather than the exception in many other countries. At the Atlanta Olympics, sports massage was officially offered at every venue; organizers had learned that it was the top medical request of athletes from many countries. One of my most memorable experiences while working at the Olympic Village in 1996 was working on a Slavic gymnast. He, and other athletes regularly getting sports massage, had soft tissue that was healthier, with less dysfunction and injury pathology, than those who weren’t. It was quite a convincer.

Some head athletic trainers may also want to introduce sports massage to their athletic director or immediate staff. These people can be included in the athletic trainers’ workshop, or you could schedule a separate introduction for them.

After your staff athletic trainers understand that sports massage is worth the investment of their time and effort, the next step is to arrange to bring sports massage to the athletes themselves. You have two basic options here: First, you can train your staff athletic trainers to perform the massage, or, second, you can hire a qualified massage therapist to treat your athletes—either as a permanent staffer or on a contract basis.

If you decide to hire, be sure the therapist is qualified. The bare minimum qualifications for a therapeutic massage therapist are: graduation from a 500 (or more) hour massage school program, passed Nationally Certified Therapeutic Massage and Bodywork (NCTMB) requirements, hold a current state license if your state has licensing, and a minimum of 28 hours of post-massage school training specifically for sports massage. Other plusses are neuromuscular therapy certification and training in activated isolated stretching.

Classrooms Are Key
If you go with the first option, training your own staff, your next question may be: Where can athletic trainers go to learn about sports massage? There are services where an athletic department can have an expert come in and teach basic sports massage techniques to athletic trainers. There are also two-day weekend workshops offered throughout the country.

I cannot stress enough the importance of having an actual teacher. Sure, there are videos and books that explain sports massage in intricate detail and with accuracy. However, sports massage is a combination of techniques that must be mastered. And those techniques are best developed in a classroom situation. In a class you will learn to work with each athlete’s unique needs, relieve trigger points and ischemia in the soft tissue, help bring the posture and gait back to balance, and more. For example, if a runner is cross stepping in his gait, you can learn which muscles to specifically treat (by both anatomically and methodologically specific techniques) to balance out this dysfunction.

An instructor is also important because he or she can view the techniques of the athletic trainers to be sure that they are doing things properly. Moreover, an instructor is there to answer questions. To put it another way, assuming that you can learn sports massage from books and videos only is about as realistic as the assumption that you can master any sport without the input of a coach.

Budgetary Concerns
If your athletic director okays the hiring of a sports massage therapist—either to treat the athletes or to teach you, some members of your athletic training staff may feel threatened if your department budget must accommodate the cost of yet another sports medicine professional. If some of your staff members have that concern, let them know that this is an investment in the health of the athletes, and that a sports massage therapist is enhancing the sports program, not diluting it.

Budgetary limitations often lead to another good question: Should you introduce therapeutic sports massage to one team at a time, or to individual athletes as the need arises? This depends on your financial constraints and physical resources. The best-case scenario is to have enough sports massage professionals available to treat all teams. But the reality is that your program may not be able to afford that level of funding.

One alternative source of funding that I have seen being used to fund sports massage programs is booster clubs. When athletes, parents, and alumni understand the benefits of sports massage, they often do fund-raising to buy equipment and even help pay salaries.

In many institutions, popular sports such as the football program can often afford what the women’s tennis program cannot. In those situations, my advice is to take the humanitarian approach, which would be to start with the individual athletes with problems. Once those athletes are treated, the word should eventually get around, and more people will begin to request sports massage therapy.


Resources:
Weekend workshops:
Ralph Stephens Seminars www.ralphstephens.com

Benny Vaughn Seminars www.bennyvaughn.com

For more articles about sports massage, log on to www.AthleticSearch.com and do a search under “massage.”



Sidebar: Techniques
There are three major categories of sports massage, along with some techniques, that athletic trainers should be aware of.

Pre-Event sports massage is done optimally 20 minutes before the athlete’s participation in the event, but can be done up to an hour before the event. The length of pre-event sports massage is about 12 minutes. The strokes used in this type of sports massage are to pump up the athletes to get them ready to rumble. They include:

Tapotement: Is very stimulating to the nervous system and is used as a stroke to stimulate the athlete.

Vibration, Shaking, and Jostling: Done rapidly, these are all stimulating strokes to the nervous system.

Compression: This stroke increases circulation and is slightly stimulating to the nervous system.

Petrissage: This is a mildly stimulating stroke to the nervous system.

Superficial (Palmar) Friction: This is a form of effleurage, however it stimulates the nervous system and generates heat.

On any athlete, you would focus your work on the primary muscles used in that sport. For example, on a runner, you would obviously pay closest attention to the lower extremities. However, low back, hips, and shoulder/arms would also benefit from a good warming up prior to the race. Stretching and ROM may also be used in pre-event work.

Post-event sports massage is effective if the work can be within six hours after the event. Post-event work takes about 15 minutes to do. The strokes used are to sedate the tissue of the athlete, remove metabolic waste from the system and decrease muscle spasm and tension after enduring the trauma to the body caused from competition. The main strokes used in post event work are:

Effleurage: After competition, this stroke is very sedating to the nervous system and moves cellular fluids and spreads fibers.

Petrissage: This stroke will be done much slower than in pre-event, but has a similar effect.

Vibration: These strokes are all done much slower than in pre-event. They are applied to specific muscles or body parts to loosen or relax.

Compression: This is a form of effleurage called nerve strokes. They are very soothing and calming.

The third type of sports massage is therapeutic sports massage. The head athletic trainer needs to consider this as a necessity in his or her program. It keeps the soft tissue in a healthier state by relieving any imbalances in the system before they take hold.

Therapeutic sports massage must be done regularly with the athlete. It is where we can do the most preventative work and scan for potential serious injuries.